Antitubercular drugs (ATT) induced hepatitis
Definition: if any of the following
1)ALT and or AST >5 times of upper limit in an asymptomatic child
2)ALT>3times in symptomatic child
3) S.bil >1.5 mg/dl
Rule out other causes of hepatitis
Management depends upon conditions of patients
In severely ill patients
Give modified ATT (LES)
L is Levofloxacin
E is ethambutol
S is streptomycin
In not severely ill patients
Stop ATT
Do weekly liver enzyme till it reached twice the normal level
Start ATT in order of RIP
R is rifampicin
I is isoniazid
P is pyrazinamide
If R is culprit, give 2HES +10 HE
If H is culprit, give RZE for 6-9 months
If Z is culprit, give 9HR
H-isoniazid
R-Rifampicin
Z-Pyrazinamide
E-Ethambutol
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